The Return of Lassa Fever, Yellow Fever, Monkeypox in Nigeria

…Why Nigeria ranks low in prevention, control

By Chioma Obinna

The outbreaks of monkeypox, yellow fever, Lassa fever and cholera among others in Nigeria highlight the failure of all tiers of government to provide effective disease surveillance, prevention, control and response strategies.

Despite Nigeria’s reliability in times past to provide laboratory diagnostic services in support of disease surveillance activities, only a few laboratories are capable of reliable diagnosis today.

Some samples are sent outside the country for laboratory confirmation.

Outbreaks of different diseases are now common in the country.

Sadly, some Nigerians have died owing to the situation, while more would still suffer the same fate if nothing cogent is done.

Simple vaccination and an effective disease control system would have saved Nigerians from the needless deaths associated with the diseases.

According to epidemiologists, although, there is little improvement in disease surveillance, poor laboratory services and lack of commitment to health budget among others make early detection, prevention, treatment, and control impossible.

Burden

According to the Nigeria Centre for Disease Control, NCDC report from 23 states, a total of 4,209 suspected Lassa fever cases were recorded in the first 42 weeks of this year.

Sadly, only 739 (17.6 percent) of these cases were confirmed by the laboratory.

In the same period, the number of suspected Lassa fever cases reported by 22 states was put at 2,761, only 539 (19. 5 percent) had laboratory confirmation.

Also, the World Health Organisation, WHO, in its epidemiological summary for Nigeria from January 1 to August 31, 2019, excluding the cases in Bauchi, revealed that a total of 2,254 suspected yellow fever cases have been reported in 535 Local Government Areas, LGAs.

All the 36 states including Federal Capital Territory (FCT) reported at least one suspected case of yellow fever.

The report said a total of 103 (74 presumptive positive and 29 inconclusive) samples were sent to yellow fever reference laboratory Institute Pasteur in Dakar (IPD) for confirmatory testing, of which 29 tested positive.

Suspected cases:

However, between August and November 2019, Nigeria has experienced an upsurge in cases of yellow fever with 511 suspected cases in three states.

The breakdown shows that 309 were recorded in Katsina, 162 in Bauchi, and 40 incidents were observed in Benue.

According to the latest NCDC report, of the samples tested from these cases, 83 were confirmed positive in Katsina, 43 in Bauchi and 6 in Benue.

This year, Katsina State has recorded 599 suspected cases, 43 confirmed cases and 77 deaths among suspected cases.

Also, Bauchi State has recorded 183 suspected cases, 34 confirmed cases and 24 deaths among suspected cases.

For monkeypox, as of September 9, 2019, NCDC said Nigeria continues to report sporadic cases of monkeypox after the index case was reported in September 2017.

A total of 81 suspected cases have been reported so far in 2019 of which 39 confirmed cases were recorded in nine states. In some states like Lagos, there is growing concern about the recent increase in the rate of gastroenteritis.

However, findings by Sunday Vanguard showed that several factors made it difficult to contain these diseases, especially Nigeria’s inability to produce vaccines locally.

The reliance on importation remains the bane of effective containment of the outbreak of hemorrhagic fevers in particular.

Currently, majority of the samples for some of the diseases are still being sent outside the country for confirmation due to lack of a national laboratory.

Outbreaks persist

Public health experts also said there is no gainsaying the fact that the failure to contain diseases like Lassa fever and the resurgence of Yellow fever can be traced to a weak system, dependent on foreign aid for surveillance needs, and low budgeting at all levels of government.

Latching on yellow fever resurgence, they lamented that Nigeria’s medical laboratory scientists were producing yellow fever vaccines in the past.

The experts added that the scientists were doing that to the point that WHO contracted Nigeria to produce yellow fever vaccines that were used to contain the yellow fever outbreak in some parts of the West African sub-region.

What really went wrong is the question on most lips.

Right now, Nigeria no longer has the in-country capacity for this vaccine production.

It is also common knowledge that all levels of government in Nigeria for many years have neglected and underfunded the health sector.

In a study published on www.preventepidemics.org, it was discovered that Nigeria is only 39 percent prepared for disease outbreaks.

National legislation

The study also showed that Nigeria recorded just 20 percent on national legislation, policy, and financing of disease outbreaks.

It further showed that on preparedness, Nigeria ranked 20 percent for emergency response operation. 

Overall, the country ranked 31 percent on ‘Stop Outbreaks’, 37 percent on ‘Protect from Other Health Threats’, 39 percent on ‘Prevent Outbreaks’, and 51 percent on ‘Find and Verify Outbreaks’

In a chat with Sunday Vanguard, a renowned Virologist, Professor Oyewale Tomori, who lamented the absence of a national functional laboratory said the national laboratory systems in Nigeria only satisfy 40 percent of the requirements for epidemic prevention and control.

According to him, in times past, Nigeria provided reliable laboratory diagnostic services in support of disease surveillance activities.

He, however, regretted that there are only a few laboratories capable of reliable diagnosis in the country.

Tomori said on yellow fever, Nigeria had to ship samples outside the country to get laboratory confirmation, adding that less than 20 percent of suspected Lassa fever cases are confirmed by Nigerian laboratory.

He explained that the situation means that Nigeria does not have the diagnosis for 80 percent of the suspected Lassa fever cases reported.

Noting that it was difficult for the country to coordinate assistance programmes that are funded and run by international organizations, he said Nigeria failed to sustain the structures and facilities that were used to control Ebola in 2014.

The renowned Virologist, who noted that although the country’s surveillance system continues to report suspected cases for other diseases, including yellow fever, monkeypox, cholera, measles, there is a need for urgent improvement on awareness, reporting, investigation and laboratory confirmation.

“Certainly, our disease surveillance is in much better shape than it was when we had an Ebola outbreak in 2014.

 

However, there is still plenty of room for improvement, especially at state and LGA, levels,” he added.

Healthcare funding

Tomori, who carpeted state governments for relying on the federal government said: “Most of the states have abandoned their responsibility and dumped everything on the federal government. This must stop.

“In some states, epidemiology divisions charged with disease surveillance have not got the transport facilities required by staff to carry out investigations. In some cases, not one kobo is budgeted or allocated for disease surveillance activities. Many have no laboratory facilities. This is unacceptable.

“On disease surveillance, states must not eat their cake and have it. They are loud in pointing out that health is a concurrent matter, but when it is time to act, they leave the responsibility for the federal government,” he stated.

Preparedness

Rating Nigeria on preparedness and response system, Tomori who referred Sunday Vanguard to a quote extracted from a publication titled: Lassa Fever: Why Nigerian Government Should Fund Disease Diagnostics For Epidemic Preparedness, authored by Chidindu Mmadu-Okoli in the July 25, 2019, edition of the Nigeria Health Watch said: “The resurgence of Lassa virus offers insights not only into Nigeria’s cultural and political health but the state of her health security, particularly, as it concerns epidemic preparedness. 

With a low epidemic preparedness level of 39 percent, limited availability of evidence-based medical care, delayed diagnosis and outbreak response, the national laboratory systems in Nigeria only satisfy 40 percent of the requirements for epidemic prevention and control.

Stemming outbreak

Tomori explained that disease surveillance and early detection are the recipes for nipping epidemics in the bud.

He said: “We must create the enabling environment for rapid investigation of reported and suspected disease outbreaks. 

Our laboratories must be provided with adequate resources – reagents, appropriate equipment, and other facilities. Also, we must improve our public awareness of these diseases, emphasizing preventive and control measures to detect, rapidly and efficiently control or respond to outbreaks.

For a renowned medical laboratory scientist, Dr. Casmir Ifeanyi, it is shameful that Nigeria still sends samples abroad for confirmation.

Ifeanyi, who is the National Publicity Secretary, Association of Medical Laboratory Scientists of Nigeria, AMSLN, said unless Nigeria revamps its medical laboratory sector by building in-country capacity for local production of vaccines, the country would continue to lag in health indices.

“We must revamp our laboratories. We must begin to build the in-country capacity of medical laboratory scientists as it was then to produce yellow fever vaccines. So long as we continue to rely on imported vaccines we would continue to have the challenge of hemorrhagic fevers.”

He called for the establishment of more laboratories in the South-East axis, particularly, in Ebonyi State.

As NCDC and other partners battle these diseases, health watchers say there is a need for a zonal public health laboratory to deal with Lassa fever, yellow fever, and monkeypox among others.